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Aims: Our objective was to evaluate the relationship between coronary chronic total occlusion (CTO) treatment strategy and quality of life improvements., Methods and Results: This multicentre prospective cohort study enrolled consecutive CTO patients undergoing a non-urgent coronary angiogram who completed the Seattle Angina Questionnaire (SAQ) and EQ-5D at baseline and at one year. Strategies were: i) medical therapy, ii) PCI to non-CTO, iii) PCI to CTO, and iv) CABG. Multivariable regression models compared quality of life changes over time among strategies, accounting for repeat measures per patient. In our cohort of 387 patients, 154 underwent medical therapy, 83 had PCI to the non-CTO artery, 104 underwent CABG, and 46 underwent PCI to the CTO. Medically treated patients had no improvement on any SAQ domains. Patients with revascularisation of the CTO territory with either PCI or CABG had significant improvements in the physical limitation (PCI to CTO 60.5-76.4; CABG 61.6-80.1; p<0.001), angina frequency (PCI to CTO 79.0-92.7; CABG 82.1-97.9; p<0.001), and disease perception (PCI to CTO 50.5-75.0; CABG 50.2-80.0; p<0.001) domains. In non-CTO PCI patients, improvement was restricted to the angina frequency (82.8-93.3; p<0.001), and disease perception (53.8-71.4; p<0.001) domains., Conclusions: CTO territory revascularisation was associated with quality of life improvements.